Using Research to Inform Practice: A Skill-Building Workshop

A Learning Institute presented by the AOSW Research Committee

Friday, June 2, 10:15 am

Presenters: • Julianne S. Oktay, MSW PhD

– Professor Emeritus, University of Maryland School of Social Work

• Bradley Zebrack, – Professor, University of Michigan School of Social Work

• Karen Kayser, MSW, PhD– Professor, University of Louisville School of Social Work

• Elizabeth Rohan, PhD, MSW – Health Scientist, CDC

• Sophia Smith, MSW, PhD– Associate Professor, Duke University School of Nursing

• Daniela Wittmann, LMSW, PhD– Clinical Assistant Professor, University of Michigan Comprehensive Cancer

Center

Workshop Overview

• Overview: 10:15 – 10:30 – Julie Oktay

• How you can use research to enhance practice and elicit system change –10:30 – 11:15 – Brad Zebrack (With Sophia Smith and Daniela

Wittmann)• Introduction to Focus Group methodology

11:15-11:45 – Karen Kayser and Elizabeth Rohan

Research in Oncology Social Work

• Early oncology social workers combined research and practice.

• Focus of oncology social work research– Focus on the clients’ experience– Life course development– Person-in-Environment (Family, community,

culture)– Social Justice

Research and AOSW Strategic Goals

• Mission • To advance excellence in the psychosocial care of persons with

cancer, their families, and caregivers through: Research Professional Development1. Identify, set, evaluate and disseminate best practices in

oncology social work2. Elevate the position and visibility of oncology social work

among the general public, the oncology community and policy makers 3. Create avenues and provide tools for oncology social work professional development through advocacy, education and research4. Advance the knowledge base of the field by building the

research capacity in oncology social work and supporting the bi-directional relationship of research and practice

Primary Types of OSW Research

HOW YOU CAN USE RESEARCH TO ENHANCE PRACTICE AND ELICIT SYSTEM CHANGE

Brad Zebrack, PhD, MSWUniversity of Michigan School of Social Work

Overview

• OSW Staffing Standards

• Using data to inform practice and program development

• Using data to influence systems

• Developing a Practice-Based Research Networks for OSW

STAFFINGWhat is the standard for OSW Staffing?

“Based on the time and tasks associated with managing highly distressed patients, social work department heads have estimated that oncology social workers can manage 10-12 highly distressed patients per month, or approximately 120 per year, in addition to also maintaining activities related to monitoring a current caseload, conducting psychosocial and psycho-educational programs and groups, facilitating patient access to community resources, discharge planning and transitioning patients from the hospital to community care.”

1 SW FTE per 400 patients

CITATION: Zebrack, B; Burg, M; Vaitones, V. (2012). Distress screening: An opportunity for enhancing quality cancer care and promoting the oncology social work profession. Journal of Psychosocial Oncology, 30; 615-624.

CALCULATE AND COMPARE

Determine your cancer program’s CoC designation:http://datalinks.facs.org/cpm/CPMApprovedHospitals_Search.htm

Cancer Registry/Program database1. # of social workers dedicated specifically to oncology

– E.g. 3.80 FTE (Full-Time Equivalent)

2. # of “analytic cases” in a given year (Caseload)– Cases diagnosed and/or receiving all or part of first course

of therapy at your facility– Different from new cases

3. # of out-patient visits in a given year (Coverage)– Includes but not limited to scheduled clinic appointments,

out-patient procedures, infusion/radiation appts

Caseload: # of analytic cases ÷ # SW FTEsExample: 4,000 cases ÷ 3.0 FTEs = 1 SW: 1,333 cases

Cancer Program Type Best Case

Worst Case

NCI-designated Cancer Program (n=11) 1: 389 1: 2,061

Compr Comm Cancer Program (n=28) 1: 131 1: 3,014Comm Cancer Program (n=21) 1: 224 1: 1,437Academic Cancer Program (n=12) 1: 270 1: 1,380Other (n=7) 1: 158 1: 612

• Citation: Guidance for Determining Oncology Social Work Staffing Standards, 2014, Association of Oncology Social Work, accessed at www.aosw.org on March 31, 2017.

Coverage: # of out-pt visits ÷ # SW FTEsExample: 25,000 visits ÷ 3.0 FTEs = 1 SW: 8,333 visits

Cancer Program Type Best Case

Worse Case

NCI-designated Cancer Program (n=11) 1: 3,600 1: 26,343Compr Comm Cancer Program (n=28) 1: 1,455 1: 126,431Comm Cancer Program (n=21) 1: 1,535 1: 29,714Academic Cancer Program (n=12) 1: 1,572 1: 37,961Other (n=7) 1: 1,162 1: 39,673

• Citation: Guidance for Determining Oncology Social Work Staffing Standards, 2014, Association of Oncology Social Work, accessed at www.aosw.org on March 31, 2017.

Caveat

• SW Roles and Responsibilities vary within and across cancer programs– Case managers– Discharge planners– Clinical– Managerial/administrative

• Current state of knowledge

• We need more specific data

TO INFORM PRACTICE & PROGRAM DEVELOPMENT

What do you do

with the data?

What can you do with

the data?

Breakdown by sub-groups

n=20

n=50

n=30

Distress Scores, n=100

Mild (0-3)Moderate (4-7)Severe (8-10)

0

10

20

30

40

50

60

70

80

Distress by Clinic

Mild Moderate Severe

Identify prevalence rates of patient concerns

67%55% 52%

32%

12% 10%22%

0%10%20%30%40%50%60%70%80%90%

100%DT and Symptom Checklist

• What do we know about psychosocial aspects of fatigue, sleep, pain, and their relationship with outcomes (e.g., tx adherence, costs)?

Breakdown by Sub-groups (Age)

0%10%20%30%40%50%60%70%80%90%

100%

Fatigue Pain Depression Transport Dealw/partner

DT and Symptom Checklist

65+ yrs 40-64 yrs 15-39 yrs

Breakdown by Sub-groups (Age)

0%10%20%30%40%50%60%70%80%90%

100%

Fatigue Pain Depression Transport Dealw/partner

DT and Symptom Checklist

65+ yrs

Breakdown by Sub-groups (Age)

0%10%20%30%40%50%60%70%80%90%

100%

Fatigue Pain Depression Transport Dealw/partner

DT and Symptom Checklist

40-64 yrs

Breakdown by Sub-groups (Age)

0%10%20%30%40%50%60%70%80%90%

100%

Fatigue Pain Depression Transport Dealw/partner

DT and Symptom Checklist

15-39 yrs

• You now have EVIDENCE!

• “Empirical data” – systematic observation

TO INFORM SYSTEMS CHANGE

Compare your patient data to national data

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%

0 1 2 3 4 5 6 7 8 9 10

Percent of cases by DT Scores

Your data APAQCC data (unpublished)

APAQCC: 46% of all cases had a DT score of 4 or higherZabora et al., 2003, reports distress by cancer type

Comparison to other Cancer Programs

3.482.85 2.67

3.002.48 2.77 2.62 2.65

1.96 2.19

1

2

3

4

5

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10

CCCP1CCCP2CCCP3CCCP4CCCP5CCCP8CCCP9

Q1: Communicates to the cancer patient and family the importance of psychosocial needs and careQ4: Identifies psychosocial health needs of cancer patientsQ5: Links cancer patient / family with needed psychosocial servicesQ6: Engages and supports cancer patient in managing their illness and healthQ7: Coordinates psychosocial and biomedical careQ8: Conducts follow-up, re-evaluation, and adjusting of psychosocial treatment planQ10: Quality oversight

Zebrack, et al., (2016). Institutional capacity to provide psychosocial oncology support services: A report from the Association of Oncology Social Work, Cancer, 122(12): 1937-1945

Questions – Small groups

• Where are clinical care issues, guidelines discussed in your cancer program?

• Are you present at those discussions? And what happens when you are?

• How have you been successful in influencing clinical care?

• What data/information have you used or needed to influence clinical care?

How might we demonstrate impact of psychosocial care?

100 Patients

30 Depressed / Distressed

Adequate Psychosocial

Response

Not Adequate Psychosocial

Response

70 Not Depressed / Distressed

Standard Care (Adequate)

30% 70%

What are your colleagues concerned about?

Patient Reported Outcomes (PROs)

• Depression, anxiety• Pain, Fatigue, Vitality/Energy• Treatment or medication adherence• Missed clinic appointments• 30-day hospitalizations

All have $$$ attached

Patient-Reported Outcome: Pain

100 Patients

30 Depressed / Distressed

Adequate Psychosocial

Response

Not Adequate Psychosocial

Response

70 Not Depressed / Distressed

Standard Care (Adequate)

30% 70%

12 Moderate-Severe Pain

(40%)

10 Moderate-Severe Pain

(14%)

Track Clinical Care

100 Patients

30 Depressed / Distressed

Adequate Psychosocial

Response

Not Adequate Psychosocial

Response

70 Not Depressed / Distressed

Standard Care (Adequate)

30% 70%

100 Patients

30 Depressed / Distressed

Adequate Psychosocial

Response

Not Adequate Psychosocial

Response

70 Not Depressed / Distressed

Standard Care (Adequate)

30% 70%

Hypothesis Time!When X happens, Y happens

When X does NOT happen, Z happens

What was the reduction in pain?

7.2

5.4

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

T1 T2

Pain

Sco

re

Change in Pain Scores, on average

Distressed, Adequate response

What was the reduction in pain?

7.2

5.47.1

7.2

0.01.02.03.04.05.06.07.08.0

T1 T2

Pain

Sco

re

Change in Pain Scores, on average

Distressed, Adequate responseDistressed, not adequate response

What was the reduction in pain?

7.2

5.47.1

7.2

4.95.1

0.0

2.0

4.0

6.0

8.0

T1 T2

Pain

Sco

re

Change in Pain Scores, on average

Distressed, Adequate responseDistressed, not adequate responseNot distressed, Standard (adequate) Care

WHAT WOULD YOU NEED TO CARRY OUT THIS OBSERVATION?

Brainstorm

Practice-Based Research Networks

• Integration of research and practice

• Power of our pooled data = demonstrates impact of ONCOLOGY SOCIAL WORK!

• Increased power =– Greater professional autonomy– Greater professional value

FOCUS GROUP METHODOLOGY

What is a Focus Group?

• Method in which moderator facilitates a discussion with a small group of people (often 6-8) who have personal or professional experience with the topic being studied

• Facilitator uses discussion guide with questions and probes

• Group’s communication and interaction stimulate ideas to identify problems and generate solutions.

When Do You Use Focus Groups?

• Need for qualitative information (e.g. deeper insights of lived experience and culture of individuals or community)

• An efficient way to obtain data• Voice of patients (Patient-centered research)• Ideas for interventions (Intervention research)• Community-based studies (requiring

community-level rather than personal information)

Who are Your Informants?

• Individuals with knowledge or information, personal or professional experience about a particular topic of interest

• Patients and/or Family Members

• Caregivers (Formal, Informal)

• Medical Or Supportive Care Providers (Nurses, Physicians, Social Workers, Psychologists, Chaplains, Etc)

• Administrators

• Community Members

• Stakeholders

Focus Group Moderator Skills

• Creating a relaxed atmosphere

• Stimulating discussion• Encouraging quiet

people to express opinion

• Curbing monopolizers• Maintaining neutrality

re: responses

Implementing the Focus Group

• Informed Consent

• Introduction

• A few questions with probes

• Audiotaping/Field notes

• Refreshments/incentives

Data Analysis• Transcribe Interviews• Open code sub-sample of transcripts to

develop and modify codebook (at least two research team members)

• Code all transcripts using final codebook (at least two research team members – 85% inter-rater reliability is goal)

• Identify unifying themes• Research team discusses, confirms, refines

themes• Don’t ignore negative cases – very informative

Case Example: Delivering Palliative Care to Inner-city Communities

Aim of study – to assess the need for a palliative psychosocial intervention for patients and families in inner city communities in Boston

Delivering Palliative Care to Inner-city Communities: Informants

Selected Case Study Interview Questions and Findings

Stresses of Daily Living

Themes

What Helps Alleviate Stress?

Themes

Intervention Based on Findings

Resources

Brown, J.B. (1999). The use of focus groups in clinical research. In B.F.Crabtree & W.L. Miller (Eds). Doing qualitative research(2nd ed., pp. 109-124). Thousand Oaks, CA: Sage.

Israel, B.A., Eng, E., Schulz, A.J., & Parker, E.A. (Eds) (2013). Methods in community-based participatory research for health, San Francisco, CA: Jossey-Bass.

Krueger, RA & Casey, MA (Eds). (2009). Focus groups: A practical guide for applied research (4th ed.). Thousand Oaks: CA: Sage.